**3. Physical activities of preschool-age children**

Children with excessive weight are less likely to exercise as they are exposed to the risk of being ridiculed by other children and thus spend most of their time watching television and eating fatty snacks [20–22]. Children who regularly exercise are less likely to develop NCDs such as type 2 diabetes and heart diseases [23].

The prevalence of obesity and obesity is rising in South Africa, causing burdens such as type 2 diabetes, asthma, liver fatty disease, cardiovascular disease, high cholesterol, sleep disorders, insulin intolerance and insulin resistance [24]. According to a study conducted by Hayes et al. [25] in Sydney, Australia, hospitalization, and medical expenditure for obese children was higher. The global obesity costs accounted for 2–7% of annual medical costs, and in the USA, the cost of treating obesity-related diseases, particularly diabetes, imposed pressure on health services, accounting for 26% of medical costs [26]. A study in Cape Town found that 13 percent of children admitted to the Red Cross War Memorial Hospital were obese and suffer from chronic diseases such as diabetes, hypertension, and heart disease [27]. Despite the Department of Social Development's efforts to provide menus for implementing adequate nutritional meals in ECDs, it was found that the food offered to pre-schoolers was mainly starchy, with little animal products and little fruit and vegetables. Inadequate pre-school menus can lead to high consumption of saturated fats, sugars, and low fibers, and can put children at risk of becoming obese [27, 28].

The National Health and Nutrition survey in South Africa showed a 13 per cent obesity rate among children aged one to five, twice the global average of 6.1 per cent [29, 30]. Despite efforts at national level, childhood obesity remains a problem in children aged 3 to 9, with the highest prevalence of obesity in Gauteng province [31]. Quality of care, including adequate food supply and participation in physical activities in preschools, has an impact on the growth and development of social, intellectual, physical, and psychological characteristics of preschool children. Consequently, it is necessary to develop and implement a pre-school obesity prevention intervention. Instigating healthy lifestyle programs in pre-schools contributes to the introduction of healthy diets and improvement of the quality of life. In South Africa, there

are currently no specific programmes to prevent obesity among children aged two to five. The current obesity strategy in South Africa targets all age groups, however, the prevalence of obesity and obesity in children is increasing. The developed programme includes a healthy lifestyle strategy for children, preschools, and families.
